Multidisciplinary Approach to Treating Severe Acute Pancreatitis in a Low-Volume Hospital
| Autor: | Moreno Elalo-Olaso A, Abella Alvarez A, Miguel Ángel García-Ureña, Gordo Vidal F, Aguilera Velardo A, San Miguel Mendez C, A. Robin-Lersundi, Cruz Cidoncha A |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Hospitals Low-Volume Abdominal compartment syndrome law.invention Sepsis 03 medical and health sciences 0302 clinical medicine law medicine Humans Aged Retrospective Studies Cholangiopancreatography Endoscopic Retrograde Patient Care Team Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test business.industry Pancreatitis Acute Necrotizing Middle Aged medicine.disease Intensive care unit Surgery Intensive Care Units Choledocholithiasis Pancreatitis Spain 030220 oncology & carcinogenesis Acute Disease Practice Guidelines as Topic Cholecystitis Acute pancreatitis Drainage 030211 gastroenterology & hepatology Female business Abdominal surgery |
| Zdroj: | DDFV. Repositorio Institucional de la Universidad Francisco de Vitoria instname DDFV: Repositorio Institucional de la Universidad Francisco de Vitoria Universidad Francisco de Vitoria |
| Popis: | Background Up to 25% of patients with acute pancreatitis develop severe complications and are classified as severe pancreatitis with a high death rate. To improve outcomes, patients may require interventional measures including surgical procedures. Multidisciplinary approach and best practice guidelines are important to decrease mortality. Methods We have conducted a retrospective analysis from a prospectively maintained database in a low-volume hospital. A total of 1075 patients were attended for acute pancreatitis over a ten-year period. We have analysed 44 patients meeting the criteria for severe acute pancreatitis and for intensive care unit (ICU) admittance. Demographics and clinical data were analysed. Patients were treated according to international guidelines and a multidisciplinary flowchart for acute pancreatitis and a step-up approach for pancreatic necrosis. Results Forty-four patients were admitted to the ICU due to severe acute pancreatitis. Twenty-five patients needed percutaneous drainage of peri-pancreatic or abdominal fluid collections or cholecystitis. Eight patients underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and biliary sepsis or pancreatic leakage, and one patient received endoscopic trans-gastric endoscopic prosthesis for pancreatic necrosis. Sixteen patients underwent surgery: six patients for septic abdomen, four patients for pancreatic necrosis and two patients due to abdominal compartment syndrome. Four patients had a combination of surgical procedures for pancreatic necrosis and for abdominal compartment syndrome. Overall mortality was 9.1%. Conclusion Severe acute pancreatitis represents a complex pathology that requires a multidisciplinary approach. Establishing best practice treatments and evidence-based guidelines for severe acute pancreatitis may improve outcomes in low-volume hospitals. pre-print 158 KB |
| Databáze: | OpenAIRE |
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